Non-Critical Care Telemetry Monitoring for Non-Cardiac Related Diagnoses: Are We Overdoing it?

From the 2018 HVPAA National Conference

Jian Liang Tan (Crozer-Chester Medical Center), Anshul Fnu (Crozer-Chester Medical Center), Aparna Fnu (Crozer-Chester Medical Center), Andrew Kunkel (Crozer-Chester Medical Center), Rahul Patel (Crozer-Chester Medical Center), Janet Fontanella (Crozer-Chester Medical Center), Sandeep Sharma (Crozer-Chester Medical Center)

Background

Telemetry is an essential tool for real-time monitoring of heart rhythm of a patient. Studies have shown a rising trend of telemetry use in non-critical care setting for non-cardiac related diagnoses due to fear of clinical deterioration and need for closer monitoring. This have led to overuse of telemetry monitoring.

Objectives

To determine the utilization patterns of telemetry in non-cardiac related diagnoses, the number of clinically significant arrhythmias, outcomes related to telemetry events, number of days that warrant a telemetry monitoring (indicated days), number of non-indicated days and the estimated financial burdens of non-indicated days.

Methods

A retrospective chart review was performed on a total of 735 patients who were admitted to a non-critical care bed over four months period (March 2017–June 2017). Inclusion criteria: Age ≥18, non-critical care beds, medicine service, at least 1 day of telemetry monitoring. Exclusion criteria: Patient with primary cardiac diagnoses or complaints. Patient records were reviewed and assessed for the appropriate use of telemetry based on our institutional guideline.

Results

Out of 735 patients, 455 patients were admitted to telemetry bed for non-cardiac related diagnoses over a four month period. Majority of them, 62.2% (283/455), had no known cardiac history. 30.1% (137/455) had inappropriate initiation of telemetry monitoring. Clinically significant arrhythmias occurred in 16.3% (74/455) of the monitored patients, andh only 8.1% (37/455) had management changes related to the telemetry events. Overall, the total number of days of telemetry monitoring over 4 consecutive months was 1465. On subgroup analysis by service, teaching service: 510 (60.1%) indicated days and 338 (39.9%) nonindicated days, whereas non-teaching service: 242 (39.2%) indicated days and 375 (60.8%) non-indicated days. No death event was reported in the non-indicated days. The estimated cost difference between telemetry ($7533) and medicine-surgery ($4727) bed per patient per night at our hospital was $7533 – $4727 = $2806. This was translated to a total waste of $2806 x 338 = $948,428 (teaching service) vs $2806 x 375 = $1,052,250 (non-teaching service) in non-indicated days over the 4 months period.

Conclusion

In our study, we found that most of the time physicians failed to discontinue the telemetry monitoring in a timely manner. We need to do a better job at discontinuing telemetry monitoring in non-cardiac related diagnoses to provide a cost-effective care for our patients.

Implications for the Patient

Cost of healthcare have increased exponentially over the past years. Given the rising trend of inappropriate use of telemetry monitoring, we urged the clinicians to take a “time-out” to think about the appropriate indications of ordering telemetry monitoring to provide a cost-effective medicine to the patients without jeopardizing their safety.

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